When is an Overpayment Identified?

The Affordable Care Act (“ACA”) amended the False Claims Act (FCA) “reverse false claims” provision to include an obligation that providers report and return any overpayment within 60 days of identification.  However, the ACA did not define identification which has caused considerable confusion among health care providers. In the recent whistleblower/false claims case of Kane v. Healthfirst, Inc., a federal district court judge has defined the term very narrowly, to mean that the overpayment is identified when the provider is… Read More >

Ohio Court Upholds Arbitration of Qui Tam Claims

The U.S. District Court for the Southern District of Ohio, Western Division, in the case of U.S. v. ex rel. Hicks v. Evercare Hospice recently granted a stay on certain qui tam claims pending arbitration. The Relators were registered nurses who worked for the Defendant hospice and alleged that the Defendants admitted patients without mandatory consent and/or power of attorney designations, billed for continuous care that was not reasonable or necessary and provided inadequate services to Medicare patients. The Relators… Read More >